tbuckley/cabot-search huggingface dataset:
The PaCES (Palliative Care Early and Systematic) Project: Impact of individual components of a multi-faceted intervention on early referral to specialist palliative care.
Authors: Aynharan Sinnarajah, Madalene Earp, Patricia Biondo, Camille Piquette, Janet Vandale, Patricia A. Tang, Marc Kerba, Sharon Watanabe, Amy Tan, Jessica Simon
Journal: Journal of Clinical Oncology (2022)

199 Background: Early referral to specialist palliative care can improve, or maintain, symptom and quality of life outcomes that matter most to patients facing life-limiting illnesses. We tested a multifaceted oncologist-facing intervention (Palliative Care Early and Systematic) in the real-world setting of a busy outpatient cancer clinic for its ability to increase the proportion of patients who receive early specialist palliative care (defined as ≥ 90 days before death). Herein, we describe how each component of the multi-faceted intervention, intended to bridge cancer, primary, and palliative care, impacted early use of specialist palliative care among advanced colorectal cancer patients. Methods: Two intervention components were implemented in Calgary, Alberta, Canada’s tertiary cancer centre from January 2019 to June 2020: 1) Adult colorectal cancer patients were referred to a community-based Clinical Nurse Specialist if they failed, or could not receive, first-line chemotherapy, or had high symptom burden (indicated by an Edmonton Symptom Assessment System Revised score ≥ 7); 2) Medical oncologists sent templated ‘Shared Care’ letters to patients’ primary care providers to improve communication, collaboration and role clarity. Results: N = 209 eligible patients died during the intervention period, of whom 57% experienced early referral to specialist palliative care. The median days from referral to death was 130 (IQR: 53-359). Of the 209, 28 (13%) saw the Clinical Nurse Specialist and received Shared Care letters, and all (100%) had early specialist palliative care referral (median 240 days, IQR: 161-359). 21/209 (10%) saw the Clinical Nurse Specialist but had no Shared Care letter. Of these 21, 76% had early specialist palliative care referral (median 197 days, IQR: 96-251). 43/209 (21%) had a Shared Care letter but no interaction with the Clinical Nurse Specialist. Of these 43, 53% had early specialist palliative care referral (median 102 days, IQR: 53-257). 117/209 (56%) did not interact with the Clinical Nurse Specialist or have a Shared Care letter. Of these 117, 45% had early specialist palliative care referral (median 86 days, IQR: 40-204). Conclusions: The Clinical Nurse Specialist was associated with the greatest increase in early specialist palliative care referral; however, the Clinical Nurse Specialist and Shared Care letters combined were associated with even greater (100%) early specialist palliative care use.
Evaluation of facilitators and barriers of timely breast cancer care in North Carolina (NC): A qualitative study.
Authors: Jacquelyne Janean Gaddy, Randall Teal, Emily Fox Bell, Stephanie B. Wheeler, Katherine Elizabeth Reeder-Hayes
Journal: Journal of Clinical Oncology (2022)

134 Background: Early detection and timely treatment of breast cancer using multi-disciplinary therapies often contributes to a goal of curative intent along with improved overall outcomes. In prior studies, Black women compared to non-Black women are at a higher chance of treatment delay (&gt; 60 days) in NC. The care team factors that contribute to these treatment delays are unclear. Methods: This qualitative study utilized content analysis. The 30 participants included community stakeholders involved in breast cancer care delivery, including breast cancer clinicians and community resource providers. Participants were selected through purposive sampling. Three Area Health Education Centers (AHEC) regions (Northwest, Charlotte, and Area L) that represent the diversity of the state of NC were selected as sites for data collection. Each participant completed a one-time semi-structured interview which was audio-recorded and transcribed. Inductively derived codes were created from the previously established interview guide leading to the production of the codebook with each code conceptually defined. Transcripts were coded by 7 coders through the method of consensus coding leading to the identification of emergent themes. Code reports were generated from each code leading to the production of a narrative summary. Results: All participants identified perceived both facilitators and barriers to the timely initiation of breast cancer treatment. Barriers fell into several categories: geographical, financial, healthcare system related, and patient related (non-financial). Most barriers were perceived as more common among Black patients. Additionally, participants emphasized incidents of historical racism in medical care that limited Black patients from having trust in the healthcare system. Facilitators identified included: outreach through community partners, healthcare navigation, supportive healthcare providers, provision of social support services, transportation, integrative services, and raising the overall quality of cancer care. Conclusions: Despite the diversity of participants regarding region, years of employment, and role, stakeholders identified important common themes when reviewing the perceived facilitators and barriers of breast cancer care delivery. Perceived barriers were largely related to patients’ social determinants of health, and participants perceived that Black patients had more adverse social determinants impacting their care timeliness, highlighting that structural racism contributes to delayed cancer care delivery. Future initiatives aimed at improving the delivery of timely breast cancer care must focus on evaluating marginalized communities’ overall access to adequate care along with effective community engagement to build a higher level of trust from such patients and target the social determinants of health.
Real-world versus clinical trial CAR T outcomes among patients diagnosed with diffuse large B-cell lymphoma.
Authors: Kaitlyn McBride, Sophie Snyder
Journal: Journal of Clinical Oncology (2022)

413 Background: Chimeric antigen receptor (CAR) T cell therapy is a high-value innovative therapy for patients diagnosed with diffuse large B cell lymphoma (LBCL). The Federal Drug Administration (FDA) has approved three CAR T-cell therapies for these patients: axicabtagene ciloleucel, tisagenlecleucel and liso-cel. Data on real-world survival and adverse events (AEs) among Medicare beneficiaries receiving CAR T is limited. This study aims to compare real-world CAR T outcomes to clinical trial results. Methods: Retrospective cohort analysis using CMS 100% Medicare Fee-for-Service (FFS) Inpatient (Part A) and Outpatient (Part B) claim files. The database contains information on inpatient and outpatient diagnoses based on the International Classification of Diseases 10th Revision-Clinical Modification (ICD-10-CM). Inpatient files were used to identify Medicare FFS beneficiaries with LBCL diagnosis (ICD-10-CM code C83.3) who received inpatient CAR T procedure between January 2020 and March 2021. Demographic characteristics (age &amp; sex), 12-month survival, and AEs were identified and compared to outcomes from three CAR T clinical trials (tisagenlecleucel: JULIET; axicabtagene ciloleucel (axi-cel): ZUMA-1; and lisocabtagene maraleucel (liso-cel): TRANSCEND NHL 001). Results: The real-world cohort (RW pts) consisted of 463 Medicare FFS beneficiaries with LBCL who were administered CAR T cell therapy inpatient between January 2020 and March 2021. A higher proportion of RW pts were aged 65 or older compared to clinical trial patients, and a lower proportion of RW pts were male (57% vs 65%). Overall, fewer RW pts experienced cytokine release syndrome (CRS) and anaemia compared to patients across the clinical trials (Table). Other common AEs, including neutropenia, fatigue, and thrombocytopenia, occurred at lower rates among RW pts compared to rates in the axicabtagene ciloleucel and liso-cel clinical trials. Survival at 12-months was comparable between RW pts and clinical trial patients. Conclusions: Study findings suggest that real-world occurrence of common AEs following inpatient CAR T administration, including CRS and anaemia, are lower compared to clinical trial outcomes. Real-world evidence of CAR T is critical for understanding real-world benefit, safety, and value of novel therapies.[Table: see text]
Patterns of molecular testing and targeted therapy use among privately insured patients with cancer.
Authors: Xuanzi Qin, Stacie B Dusetzina
Journal: Journal of Clinical Oncology (2022)

133 Background: Despite increased molecular testing (MT) for cancers with actionable biomarkers, the NCCN guidelines only recommend comprehensive MT for newly diagnosed patients with metastatic non-small cell lung cancer (mNSCLC). Methods: We used IBM MarketScan Claims to examine MT and Tx use among privately insured patients &lt; 65 yrs. We identified 101,456 patients with new colorectal, lung, breast, ovary, or prostate cancers or melanoma between 2017-2019. We used procedure codes to identify MT receipt within 6 months after the cancer diagnosis. We divided MTs into three categories: single-gene, panel, or unspecified MTs (tests without a uniquely assigned procedure code). We also identified the use of targeted therapy in the year after the cancer diagnosis. Results: Among 101,456 patients, 14,657 (14.4%) received MT, and 8,166 (8.0%) received targeted therapy. Use patterns varied across cancers (Table). Patients with breast, colorectal, or ovary cancers were more likely to receive MT. Patients with lung cancer were most likely to receive panel tests. Patients with breast cancer were most likely to receive single-gene tests. Patients with lung cancer were the most likely to receive targeted therapy, with or without MT. Median days from diagnosis to MT was the shortest for lung cancer and the longest for prostate cancer. Median days from diagnosis to targeted therapy was the shortest for lung cancer and the longest for ovary cancer. Conclusions: We observed higher uptake of MT among individuals with lung cancer, consistent with recent guidelines. However, the high use of single-gene tests among patients with lung cancer, the receipt of targeted therapy without MT among patients with breast or lung cancers, and the use of multiple types of MT might suggest poor quality of care. Moreover, despite multiple actionable biomarkers, the uptake of MT was low in other cancers. Patients with other cancers might not benefit from the advances of cancer precision medicine due to the lack of clear guidelines.[Table: see text]
Implementation of a longitudinal quality improvement curriculum for hematology/oncology fellows.
Authors: Samantha DiBenedetto, Philip Young, Pooja Mehra, Richard Delmar Hall, Michael Kenneth Keng
Journal: Journal of Clinical Oncology (2022)

315 Background: Quality improvement (QI) is an integral part of healthcare systems and an essential skill for trainees to develop. Education and engagement in QI activities is an ACGME core competency for GME trainees regardless of program or post-graduate year (PGY). There are many ways in which these competencies may be fulfilled and often vary widely between programs and institutions. Here we present the implementation of a longitudinal QI curriculum for hematology/oncology fellows at our institution. Methods: In July 2020 we implemented a 3-year longitudinal QI curriculum to meet criteria set forth by ACGME regarding QI training to improve fellow engagement in QI activities. The curriculum consists of 3 components: 1) introductory lectures on QI concepts and methodology including PDSA cycle and Lean Six Sigma, 2) monthly morbidity &amp; mortality conferences utilizing root cause analysis to identify opportunities for improvement, and 3) fellow-initiated QI projects with regular feedback sessions. Fellows are encouraged to participate in ASCO’s Quality Training Program (QTP) for further project development. A senior QI fellow is appointed to organize didactics and oversee project development. Milestones are set per training year. PGY1 fellows participate in didactics and feedback sessions to gain understanding of QI methodology and application to ongoing and future projects. PGY2 fellows develop and implement a project utilizing core QI principles. PGY3 fellows complete their longitudinal QI project, culminating in presentation and conference submission. At the conclusion of the curriculum, fellows are expected to achieve competency in 1) identifying clinical and institutional opportunities for QI, 2) understanding and applying QI concepts and methodology to project development, and 3) designing and implementing a QI project utilizing core concepts and methodology. Pre- and post-curriculum self-assessments will be used to evaluate knowledge of QI principles. Results: Since implementation fellows have actively participated in all components of the QI curriculum resulting in improved fellow satisfaction in QI education and engagement. Four fellow-initiated QI projects have been developed, resulting in 1 participation in ASCO QTP, 3 presentations at departmental grand rounds, and 3 abstract presentations at national meetings including ASH Annual Meeting, ASCO Annual Meeting, and ASCO Quality Symposium. Two projects have been completed, leading to interventions that have been implemented into routine practice at our institution. Conclusions: Implementation of a longitudinal QI curriculum at our institution has resulted in improved fellow experience in QI and successful implementation and presentation of QI projects at both the local and national levels. This curriculum has been well received by both fellows and faculty and has led to improved engagement in QI education and practices.
Defining key care events to integrate biomarker testing in the workup for patients with advanced non–small cell lung cancer (aNSCLC).
Authors: Nikki A. Martin, Latha Shivakumar, Leigh Boehmer, Ashley Lile, Stephanie A. Cohen, Amy Jo Pixley, Elana Plotkin, Julia R. Trosman, Christine B. Weldon
Journal: Journal of Clinical Oncology (2022)

346 Background: Biomarker testing is critical in management of aNSCLC, but timely testing for newly diagnosed patients is challenging. Clinician and patient perspectives on barriers to timely biomarker testing for patients with health disparities have been reported (Boehmer et al 2021, 2022; Martin et al 2022). To address barriers, we are developing a novel intervention to integrate biomarker testing into aNSCLC workup using the 4R Oncology Model (Trosman et al 2016, 2021). The intervention facilitates timing and sequencing of key care events enabling biomarker testing as well as incorporating clinician and patient perspectives. We report care events which form the foundation of the intervention. Methods: We conducted focus groups with 12 clinicians at 3 Association of Community Cancer Centers (ACCC) member programs. Each clinician treats patients with NSCLC and socioeconomic and/or health disparities. Results: We identified 5 key care events facilitating biomarker testing that should be integrated into workup for patients newly diagnosed with aNSCLC (Table). For each event, we defined dependency to enable timing and sequencing of care and considerations for clinicians and patients. Conclusions: The 5 key care events, dependencies, and clinician and patient considerations represent a basis for incorporating biomarker testing into the aNSCLC workup that is both patient and clinician centric. Implementation and evaluation of the 4R Oncology model incorporating the 5 key care events are underway at 3 cancer centers.[Table: see text]
Transitions in care for ER patients with a suspected cancer diagnosis.
Authors: Megan Roy, Margaret Rummel, Eleanor Miller, Katie L. Fanslau, Patricia Gambino, Keith Hemmert
Journal: Journal of Clinical Oncology (2022)

117 Background: The oncology nurse navigators (ONNs) at Penn Medicine’s Abramson Cancer Center (ACC) observed that patients seen in the Emergency Room (ER) and found to have a suspicion of cancer were being told to call a medical oncologist. The oncologist in the ACC are highly specialized and since the patient has not had a confirmed cancer diagnosis, they were being told they couldn’t schedule an appointment. Some patients waited for the ACC to call them to schedule. When this didn’t happen they would call the ACC a week later. These barriers led to delays in care, poor patient experience, and a financial loss for the health system. The ONNs identified this as an opportunity to change the process to improve patient care. Methods: The initiative formally began in June 2021 when the ONNs reached out to the ER leadership to collaborate on a quality improvement project to streamline the process from ER visit to oncology work up and diagnosis. Direct referral to oncology nurse navigation from the ER facilitates timely navigation assessment and coordination of care. The Plan Do Study Act (PDSA) methodology was utilized. A “Consult to Nurse Navigation” order was built into the electronic medical record (EMR) for ER providers to directly refer patients to the navigation team. The ONNs contacted the patient within one business day to assess next steps. The ONNs scheduled the patient with the appropriate oncology specialist. The ONNs follows the patient through the diagnostic phase of care and assists with decreasing barriers to care. Data collection is ongoing to assess the impact of the interventions. Results: The EMR consult to ONNs went live April 2022. It includes 3 hospital ERs in the health system with diverse populations that often have limited access to health care. To date, 90% were appropriate referrals and triaged to cancer specialists for diagnostic workup and treatment. 90% had insurance accepted by the health system. Patients with unacceptable insurance plans were referred to ER social work and financial advocates. 70% were diagnosed with cancer and began treatment. Conclusions: ONNs are vital in identifying and removing barriers to care. The ONN team’s clinical knowledge, assessment skills, and expertise of the Penn health system have closed a gap in care while increasing patient satisfaction, patient retention, and downstream revenue. The ONNs leadership has directly enhanced the diagnostic process and timeliness to care for patients newly effected by cancer.
Growth and scalability of a palliative care program in a large community oncology practice.
Authors: Sandhya Mudumbi, Stephen Matthew Schleicher, Larry Edward Bilbrey, Barton Sanders, Maribeth Bosshardt, L. Johnetta Blakely, Natalie R. Dickson
Journal: Journal of Clinical Oncology (2022)

206 Background: Tennessee Oncology (TO) is a large community oncology practice with over 180 oncology providers spanning over 30 clinics throughout Tennessee and northern Georgia. In 2017, TO began embedding palliative care (PC) providers in clinics. However, the program growth was slow and by the end of 2019, TO offered PC services within only five clinics. In early 2020, TO implemented various initiatives to expand access and improve utilization of palliative care. Methods: In May 2020, TO hired a palliative care physician to grow and oversee the program. TO physician leadership established and communicated the importance of PC to providers and began providing feedback to each provider on utilization of PC for metastatic lung and pancreatic cancer patients. These diseases were selected due to poor prognosis, high morbidity, and known benefit of palliative care. Expansion of telemedicine reimbursement helped our PC team offer in person and telemedicine visits. Increasing demand allowed for expansion of the team and hiring of additional physicians, advanced practice providers (APPs), and a PC nurse coordinator to provide triage, follow-up and scheduling for PC providers. Results: Between the end of 2019 and the end of 2021, the average number of PC visits per quarter (averaged across three quarters) increased from 1,279 to 2,480, representing a growth of 194%. During this time, TO provided over 19,600 PC visits for 3,955 unique patients, of which 53% were female and 47% were male. Of visits provided, 40% were performed through telemedicine. The program has grown from five providers to 11 providers (three physicians, eight APPs). The number of clinics offering in person PC services has grown from five to 13. The three most common malignancies associated with patient visits were lung (16%), breast (10%), and colorectal (7%). Conclusions: Embedding palliative care within a large community oncology practice is feasible and can grow rapidly. A combination of in-person and telemedicine visits can expand reach to improve accessibility across a large patient population.
Evaluation of clinical use of intravenous iron: Utilization, efficacy, and safety in the management of cancer and chemotherapy-induced anemia in GI oncology.
Authors: Leila Rostamnjad, Houry Leblebjian, Jennifer Falb, Meghan Dolan, Karen A. Sommer, Nadine Jackson McCleary
Journal: Journal of Clinical Oncology (2022)

359 Background: National Comprehensive Cancer Network recommends intravenous (IV) iron therapy for management of cancer and chemotherapy induced anemia without mentioning agent preference. Currently at Dana-Farber Cancer Institute (DFCI), all IV iron formulations can be utilized in management of iron deficiency anemia. This study was performed to evaluate the utilization, efficacy, and safety of IV iron formulations in management of cancer and chemotherapy induced iron deficiency anemia in patients with gastrointestinal (GI) cancer. Methods: Retrospective chart review was performed on DFCI patients with GI cancer undergoing palliative or adjuvant chemotherapy who received ferric gluconate, ferumoxytol, or iron sucrose between January 2021 and January 2022. Patients were identified using electronic medical record reports. Data was collected on cancer diagnosis, chemotherapy regimen, total IV iron dose and frequency, infusion reactions, laboratory values including hemoglobin, mean corpuscular volume (MCV), and iron status parameters (serum iron, ferritin, transferrin, iron-binding capacity, transferrin saturation) at baseline and 4-6 weeks after the last dose. The primary outcome was to assess the utilization of different IV iron formulations. Secondary outcomes were efficacy defined as mean absolute change from baseline in Hemoglobin levels and safety defined as incidence of hypersensitivity reactions. Results: 102 patients were evaluated of which 61 received ferumoxytol, 36 ferric gluconate and 5 iron sucrose. All patients had baseline hemoglobin (≤11 g/dL) and MCV collected. 89 patients had baseline iron status parameters (serum iron, ferritin, transferrin, iron-binding capacity, transferrin saturation). Most patients (N = 70) had diagnosis of colorectal cancer and received chemotherapy every 2 weeks. All patients received recommend total dose of IV iron on days of chemotherapy which was outside the recommended schedule of the IV iron formulations. A gradual increase in Hemoglobin concentrations in patients treated with IV iron was observed. Conclusions: Ferumoxytol and Ferric Gluconate were the most utilized IV iron formulation at DFCI GI oncology patients. All patients received recommended IV iron dosing but did not follow the recommended schedule. All patients had hemoglobin and MCV checked before each IV iron therapy. IV iron therapy was well tolerated and effective in treatment of iron-deficiency anemia in patients with gastrointestinal cancer undergoing chemotherapy.[Table: see text]